EverCare pays $18 mill in hospice case on whistleblower claims that patients were not terminally ill

EverCare, doing business now as Optum Palliative and Hospice Care, A Minnesota-based company that operates in Colorado will pay $18 million after falsely claiming Medicare reimbursement for patients who were not eligible for hospice care. A whistleblower lawsuit, alleging that the provider knowingly submitted or caused false claims to be submitted to Medicare for hospice care from Jan. 1, 2007, through Dec. 31, 2013. These invoices were proved false by Evercare’s medical records, revealing that patients receiving Medicare hospice benefits even though they were not terminally ill.

The whistle-blower lawsuits were originally filed by former Evercare employees. The government intervened under provisions in the False Claim Act and alleged that Evercare’s business practices were designed to maximize the number of patients it could bill Medicare for by discouraging doctors from discharging ineligible patients from hospice and failing to ensure accurate records were kept for patients’ conditions.

Hospice care is special end-of-life care for terminally ill patients intended to comfort the dying. When a terminally ill Medicare patient elects hospice, Medicare no longer covers traditional medical care designed to improve or heal the patient. Only Medicare patients who have a life expectancy of six months or less are considered terminally ill and eligible for the Medicare hospice benefit.

The company business practices also allegedly included discouraging doctors from recommending that ineligible patients be discharged from hospice and failing to ensure that nurses accurately and completely documented patients’ conditions in the medical records.